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Fine Needle Aspiration Biopsy Cytology of Soft Tissue: A Diagnostic Approach Based on Pattern Recognition

Primary soft tissue lesions pose a challenge to many cytopathologists because of the relative rarity of these lesions in comparison with those of other organ systems, the lack of familiarity with soft tissue tumors on fine needle aspiration biopsy (FNAB) and tissue biopsy, and the limitations of FNAB in subclassifying some soft tissue tumors. However, although subclassification of these lesions may be diagnostically challenging, it is…

Fine Needle Aspiration Biopsy Cytology of Kidney: A Diagnostic Approach Based on Pattern Recognition

Fine needle aspiration biopsy (FNAB) of the kidneys is a safe procedure with an excellent diagnostic yield based on established criteria for primary lesions with a sensitivity of 80% to 92% and specificity of 83% to 100% in diagnosing malignancy. The use of rapid on-site evaluation of the FNAB can reduce the need for core biopsy. But there are benefits to using a combined fine needle…

Fine Needle Aspiration Biopsy Cytology of Lung and Mediastinum: A Diagnostic Approach Based on Pattern Recognition

Currently, fine needle aspiration biopsy (FNAB) is the first diagnostic procedure used in patients presenting with a mass in the lung, mediastinum, or chest wall on chest x-ray (CXR) or computed tomography (CT) or CT positron emission tomography (PET) scan, which may have been performed as a routine screening procedure or as a part of the workup in patients with chest-related symptoms, pneumonia, malignancy in another…

Fine Needle Aspiration Biopsy Cytology of Pancreas: A Diagnostic Approach Based on Pattern Recognition

The number of pancreatic fine needle aspiration biopsies (FNAB) has increased substantially over the past decade due to (1) the development of new imaging and guidance mechanisms, specifically endoscopic ultrasound scopes with the ability to perform an ultrasound directed FNAB; (2) the increased sensitivity of detection of incidentally discovered masses; and (3) the improved recognition and classification of cystic neoplasms. Still today, pancreatic FNAB represent one…

Fine Needle Aspiration Biopsy Cytology of Liver: A Diagnostic Approach Based on Pattern Recognition

Acknowledgement John M. Ferguson, MD, contributed the section on “Fine Needle Biopsy of Liver Lesions—A Radiologist’s Perspective.” With the routine use of imaging to investigate patients with abdominal symptoms or to screen patients with cancer, increasing numbers of localized liver lesions are being detected. Fine needle aspiration biopsy (FNAB) of the liver is commonly performed to investigate these localized mass lesions or “tumors.” The aim of…

Fine Needle Aspiration Biopsy Cytology of Breast : A Diagnostic Approach Based on Pattern Recognition

The technique of fine needle aspiration biopsy (FNAB) of breast has developed over the past 60 years to be an extremely useful and accurate method of diagnosing palpable and impalpable lesions. Breast FNAB can attain sensitivity in the range of 90% to 95% and a positive predictive value (PPV) of malignancy of 99%, with a very low false-positive rate, usually related to FNAB of fibroadenomas, papillomas,…

Fine Needle Aspiration Biopsy Cytology of Thyroid: A Diagnostic Approach Based on Pattern Recognition

Fine needle aspiration biopsy (FNAB) of the thyroid is currently the most accurate and cost-effective way of examining thyroid nodules (2009 American Thyroid Association guidelines). The number of thyroid FNAB has increased recently due to the number of thyroid nodules that are being discovered by ultrasound, which is used to supplement routine physical examinations. FNAB of the thyroid has made it possible to diagnose the vast…

Fine Needle Aspiration Biopsy Cytology of Lymph Nodes: A Diagnostic Approach Based on Pattern Recognition

Acknowledgements The authors gratefully acknowledge the generous provision of illustrations by Dr. M. Mallik ( Fig. 3-2 ), Dr. T. Lioe ( Fig. 3-3 ), and Dr. Y. Gong ( Fig. 3-20 ), and Dr. Andrew Field ( Plates 3-1A and C, 3-2A and C, 3-3A and C, 3-4A and C, 3-5A and C ). We also appreciate the valuable help of Mrs. Debra Holder in…

Fine Needle Aspiration Biopsy Cytology of Salivary Gland: A Diagnostic Approach Based on Pattern Recognition

Fine needle aspiration biopsies (FNAB) of salivary gland and head and neck lesions can represent a major component of the total volume of FNAB in a pathologist’s practice. These specimens can also be the most challenging due to the number and complexity of the lesions in the head and neck area. It is difficult to memorize all of the possible variations that many salivary gland and…

Introduction to the Practical Algorithmic Pattern Recognition Approach to Fine Needle Aspiration Biopsy

FNAB Pattern Recognition Numerous texts over the past 50 years have described the attributes of fine needle aspiration biopsy (FNAB). The purpose of this text is not an attempt to replace these salient works in diagnostic cytopathology of FNAB lesions. This book serves as a “field guide” to the diagnosis of lesions by FNAB, incorporating a practical algorithmic pattern recognition method to achieve this goal. This…

Margin Assessment of Cutaneous Melanoma

Once a diagnosis of primary cutaneous melanoma has been established by a pathologist, the treatment of choice is usually complete removal by surgical excision. Surgery is to accomplish two goals: (a) to permit complete assessment of the entire tumor for prognostic purposes and (b) to minimize risk for metastasis. For in situ melanomas complete surgical removal is curative. If the primary melanoma is confined to the…

Prognosis, Staging, and Reporting of Melanomas

Prognostic information is helpful for individual patients affected by melanoma to understand their likely clinical outcome. However, it is also important for clinicians to assist them in making management decisions and for the design, conduct, eligibility, and analysis of clinical trials. Approximately 90% of melanomas are diagnosed as primary tumors localized to the skin, with no evidence of metastatic disease at the time of diagnosis. The…

Clinical, Dermoscopic, Pathologic, and Molecular Correlations

Pathologists will inevitably encounter melanocytic neoplasms, which are difficult to classify as melanocytic nevus or melanoma by histopathologic examination alone. While diagnostic confidence and uncertainty depend on one's level of experience and expertise, even the most experienced melanocytic lesion expert will face cases for which a definitive diagnosis by microscopic assessment alone cannot be provided due to the presence of ambiguous morphologic features. Some of these…

Molecular Techniques

Despite our advances in understanding the pathogenetic processes involved in tumor progression, the diagnosis of melanocytic tumors relies primarily on examining morphological features on hematoxylin-and-eosin stained slides. However, for some tumors there are limitations to the sensitivity and specificity of a diagnostic assessment purely based on morphological features. Ancillary diagnostic techniques may assist in establishing a precise diagnosis, such as the distinction of clear cell sarcoma…

Immunohistochemistry for the Diagnosis of Melanocytic Proliferations

Immunohistochemistry (IHC) is an important ancillary method for the histopathologic diagnosis of melanocytic proliferations. Its purpose is to correlate the presence or absence of an antigen of interest with a cell or group of cells, such as to determine its line of differentiation. Antibodies to several antigens associated with melanocytic differentiation are available (see below). They help visualize melanocytes of normal skin ( Fig. 29.1 )…

Dermoscopy for Dermatopathologists

Prior to the 1970s dermatologists had the advantage of analyzing the clinical morphology of lesions with their histopathology-trained eye and the microscopic morphology with their clinically trained eye. With the creation of dermatopathology as a subspecialty in the 1970s, clinical dermatology and histopathology uncoupled. This separation has made clinical-pathologic correlation more difficult. The importance of integrating both the clinical and pathology findings for accurate diagnosis is…

Metastatic Melanoma

Most patients with primary cutaneous melanoma will be cured by surgery. However, metastatic disease develops in approximately 15% to 30% of patients. Most metastases manifest after the diagnosis of the primary melanoma, usually within less than 3 years, rarely up to decades later. On occasion the metastatic disease may be apparent at the same time when the primary tumor is found or present in the absence…

Melanocytic Nevi in Lymph Nodes

The presence of benign melanocytes within lymph nodes was first reported by Stewart and Copeland. The frequency of their detection in lymph nodes ranges from less than 1% to up to 25% in some studies. It is likely that this variation reflects differences in study populations, the extent of lymph node tissue sampling, and the utilization of immunohistochemical stains. There is some evidence that the frequency…

Primary Melanocytic Neoplasms of the Central Nervous System and Melanotic Schwannoma

Although metastases originating from cutaneous melanomas account for the large majority of melanocytic neoplasms encountered in the human central nervous system (CNS), the latter include tumors that arise within the meninges or, less often, the neuroparenchyma proper. These are presumed to derive via the neoplastic transformation of cells that migrate as melanoblasts from the neural crest to the leptomeninges. Accordingly, such tumors are collectively designated as…

Mucosal Melanocytic Tumors

Mucosal Melanocytic Nevi Melanocytic nevi rarely grow at mucosal sites. Mucosal nevi are most often found affecting the conjunctiva or oral mucosa. Conjunctival mucosal nevi are discussed in a separate chapter. Oral mucosal melanocytic nevi are usually discovered during a routine intraoral exam. They are typically asymptomatic, presenting as well-defined brown macules, papules, patches, or plaques ( Fig. 24.1 ). There are limited data available on…